Lamar Op-Ed

Your Health - Electronic medical records

I just read about a two year, 20 billion dollar program to digitize American medical records. The new healthcare wizards are once again beating their drums in support of electronic medical records, promising savings, increased efficiency, and greater safety.

"Look, going to e-prescriptions will save countless lives. Have you ever seen the way some hand written prescriptions look? What is it with doctors and handwriting?"

Okay, okay, I admit it. Docs often have handwriting that would have stumped those English guys who broke WW II Nazi secret codes. One of my more embarrassing moments occurred when an election officialâ a vicious third grade teacherâ challenged my identity on the basis that my signature only vaguely looked like the one on file, the one I'd signed before medical school.

"What is this, Doctor Waggoner, a signature? NO, it's a scrawl. Ten years ago you had a signature. Now? Now I don't know what you have!"

Of course this took place 15 minutes before the polls were supposed to close, and there were about 40 people waiting in line behind me. I finally promised to buy a Big Chief tablet and practice my curls and circles for 10 minutes every night. She let me vote. I never found out about the people behind me. I left the voting machine on a dead runâ no exit polls for this boy. I'm no fool.

Docs sign so many forms, notes, and prescriptions that after a time our hands refuse to make anything other than a cursory effort. It's a protective reflex. We're innocent. We have no control over it.

Advertisement

If we tried to sign things legibly, our neurological systems would compensate elsewhere. If you ever find a doctor with a legible signature, take a little closer look at him or her. Know what you'll see? On some part of his or her body, the nerves will be compensating for that legible signature. A leg will be twitching, an eye will be involuntarily rolling around, or you will hear little sounds under the doctor's breathâ "Gabbglopdodeedaw â ¦snort, snort."

So, it would seem that e-prescriptions make sense, right?

Maybe not. A number of studies have demonstrated that new sort of mistakes crop up when e-scripts are used. The nature of these mistakes varies with how the prescription is entered.

For example, some systems use a highlight system. The provider highlights the drug and dosage and hits enter. Tell me honestlyâ how many times have you entered your address into a computer only to discover that when it appeared on a final checkout or final address label you claimed to live in Eads, McClave, or Lamar, California. The little cursor thing slipped didn't it? But no big deal. The computers know that Eads is in Colorado because of the ZIP code.

With a prescription, there is no zip code. If the cursor slips from Depakote 250 mg. to Depakote 500 mg., how will that be caught? A messy prescription prompts an angry call from a nurse or pharmacist to a doctor. But with e-scripts, the size of the pill being prescribed is completely legible, pristine in its Arial font. It may be wrong, but it's quite legible.

And that happens. In fact, one study suggested that personnel became far less vigilant with e-scripts than they had been with written prescriptions. "Hey, the computer will check it, right?"

Anything that reduces vigilance in healthcare professionals kills people. It's the PEOPLE who make medical care safe, not the form in which the record is stored.

I now get records generated from computerized offices and emergency rooms that list incredibly complete examinationsâ some going on for a half page or so. I've discovered two things about these records.

First, I have to really hunt through a ton of verbiage to find pertinent information.

Second, I don't believe for a minute that what the record says was done was actually done. I've worked in enough emergency rooms to know that no ER doc treating a child with an ear infection is going to do air pressure studies on the infected ear. Blowing air at a red hot ear drum might be standard of care at Guantanamo but not in the good old USA. And yet, there it is in the digitized description of an ER exam, "Monometry of affected ear revealed drum to be under pressure."

Standardized descriptions of exams are useless. They are misleading. They are bad medicine. I would rather see a record written on an index card that said, "Tonsils really big and covered with pus. Breath smelled like strep. Gave penicillin," than a computer generated report that listed a variety of findings that may or may not have actually been noted. The index card can be believed. Is it cursory care not supported by evidence based medicine? Yup. But the record is honestâ saw this, did that.

I don't care if a medical record is on a page from a Big Chief notebook. If it's accurate and makes the pertinent findings easily accessible, as far as I'm concerned, it's a helluva record.

Should medical records be legible? Of course. Should medical records be available every time a patient is seen? You betcha. They are worthless if they're not present when a patient needs them. Will computerized systems answer these two concerns? Maybe. But an available, legible record that is constructed of inaccurate, imprecise data, and exaggerated examinations is a deadly trap.

I'm willing to bet you'll not hear that concern voiced by any of those who are about to dip their hands into that 20 billion dollars.